<%@ page language="java" contentType="text/html; charset=utf-8"
	pageEncoding="utf-8"%>
	<div class="modal modal-flex fade" id="modalCreate" tabindex="-1" role="dialog"
		aria-labelledby="myModalLabel" aria-hidden="true">
		<div class="modal-dialog">
			<div class="modal-content">
				<div class="modal-header">
					<button type="button" class="close" data-dismiss="modal">
						<span aria-hidden="true">&times;</span><span class="sr-only">Đóng</span>
					</button>
					<h4 class="modal-title" id="adminRegisterModalLabel">Tạo mới cửa hàng thuốc</h4>
				</div>
			<form action="create">
				<div class="modal-body">
					<div class="mb10 input-group">
						<span class="input-group-addon">Tên &nbsp; &nbsp;&nbsp; &nbsp;&nbsp; &nbsp;
							&nbsp; &nbsp; &nbsp; &nbsp;</span> <input type="text"
							class="form-control" placeholder="Name" name="createName" id="createName"
							required>
					</div>
					<div class="mb10 input-group">
						<span class="input-group-addon">Địa chỉ &nbsp; &nbsp;
							&nbsp; &nbsp; &nbsp; &nbsp;</span> <input type="text"
							class="form-control" placeholder="Address" name="createAddress" id="createAddress">
					</div>
					<div class="mb10 input-group">
						<span class="input-group-addon">Số điện thoại&nbsp;
						</span> <input type="text" class="form-control" id="createPhone"
							placeholder="Phone" name="createPhone">
					</div>
					<div class="mb10 input-group">
						<span class="input-group-addon">Trạng thái &nbsp; &nbsp;&nbsp;
							&nbsp;</span>
						<div class="form-control">
							<input  type="text" list="createStatusList" id="createStatusInput" name="createStatus"
								style="width: 100px;">
							<datalist id="createStatusList">
									<option value="Active"/>
									<option value="Inactive"/>
							</datalist>
						</div>
					</div>
				</div>
				<div class="modal-footer">
					<button type="submit" class="btn btn-primary">Lưu</button>
					<button type="button" class="btn btn-default" data-dismiss="modal">Đóng</button>
				</div>
			</form>
			</div>
		</div>
	</div>